Asia’s drug problem is ravaging communities at an alarming rate, but in the nation of Myanmar, the drug addiction epidemic has become so pervasive that shopkeepers give customers syringes as change when they do not have currency.

In “Silent Offensive,” a stunning report by the Kachin Women’s Association of Thailand–a women’s group covering the border region between Thailand and Myanmar–drug addicts and their families tell stories of the horrific lengths to which heroin addicts will go to feed their addiction, and just how pervasive heroin is in certain communities. As the Global Post notes, a customer in some areas of the Kachin border state will receive syringes as change in stores. Previously, store owners would also dispense candy or cigarettes instead of money, as customers perceived these to be more valuable than actual Burmese money. The report notes that, in addition to syringes, “gas stations also make change using bottles of sterile water, which addicts draw into syringes to turn powdered heroin into an injectable liquid.”